title: Rationale and design of the Multicenter Medication Reconciliation Quality Improvement Study (MARQUIS).
abstract: BACKGROUND
  Unresolved medication discrepancies during hospitalization can contribute to adverse drug events, resulting in patient harm. Discrepancies can be reduced by performing medication reconciliation; however, effective implementation of medication reconciliation has proven to be challenging. The goals of the Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) are to operationalize best practices for inpatient medication reconciliation, test their effect on potentially harmful unintentional medication discrepancies, and understand barriers and facilitators of successful implementation.
  
  
  METHODS
  Six U.S. hospitals are participating in this quality improvement mentored implementation study. Each hospital has collected baseline data on the primary outcome: the number of potentially harmful unintentional medication discrepancies per patient, as determined by a trained on-site pharmacist taking a "gold standard" medication history. With the guidance of their mentors, each site has also begun to implement one or more of 11 best practices to improve medication reconciliation. To understand the effect of the implemented interventions on hospital staff and culture, we are performing mixed methods program evaluation including surveys, interviews, and focus groups of front line staff and hospital leaders.
  
  
  CONCLUSIONS
  At baseline the number of unintentional medication discrepancies in admission and discharge orders per patient varies by site from 2.35 to 4.67 (mean=3.35). Most discrepancies are due to history errors (mean 2.12 per patient) as opposed to reconciliation errors (mean 1.23 per patient). Potentially harmful medication discrepancies averages 0.45 per patient and varies by site from 0.13 to 0.82 per patient. We discuss several barriers to implementation encountered thus far. In the end, we anticipate that MARQUIS tools and lessons learned have the potential to decrease medication discrepancies and improve patient outcomes.
  
  
  BACKGROUND
  Clinicaltrials.gov identifier NCT01337063.
authors.affiliation: Geriatric Research, Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA. Amanda.Salanitro@Vanderbilt.Edu
authors.forename: Amanda H
authors.initials: AH
authors.lastname: Salanitro
authors.forename: Sunil
authors.initials: S
authors.lastname: Kripalani
authors.forename: Joanne
authors.initials: J
authors.lastname: Resnic
authors.forename: Stephanie K
authors.initials: SK
authors.lastname: Mueller
authors.forename: Tosha B
authors.initials: TB
authors.lastname: Wetterneck
authors.forename: Katherine Taylor
authors.initials: KT
authors.lastname: Haynes
authors.forename: Jason
authors.initials: J
authors.lastname: Stein
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Kaboli
authors.forename: Stephanie
authors.initials: S
authors.lastname: Labonville
authors.forename: Edward
authors.initials: E
authors.lastname: Etchells
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Cobaugh
authors.forename: David
authors.initials: D
authors.lastname: Hanson
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Greenwald
authors.forename: Mark V
authors.initials: MV
authors.lastname: Williams
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Schnipper
mesh_terms: D019985:Benchmarking; D006801:Humans; D007318:Inservice Training; D008505:Medical Staff, Hospital / Q000592:standards; D008508:Medication Errors / Q000517:prevention & control / Q000706:statistics & numerical data; D059065:Medication Reconciliation / Q000458:organization & administration; D015279:Organizational Culture; D010595:Pharmacists / Q000592:standards; D017064:Process Assessment, Health Care / Q000379:methods / Q000592:standards; D058996:Quality Improvement; D012107:Research Design; D017751:Safety Management; D013997:Time Factors; D014481:United States